The Emerging Threat of Multidrug-Resistant Tuberculosis: Global and Local Challenges and Solutions

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1 The Emerging Threat of Multidrug-Resistant Tuberculosis: March 3-4, 2010 Roode Vallei Country Lodge With the development of antibiotics in the twentieth century, tuberculosis gradually lost its central position as a global health concern it was considered a disease of the past or one that was only associated the extreme poverty of the developing world. However, this view of tuberculosis is out of date. Tuberculosis is today one of the leading causes of death in the world 4500 people die daily from the disease. Although many cases of TB can be cured by available antibiotics, multidrug-resistant TB (MDR TB) is a major and growing threat worldwide. Strains of TB resistant to even the second line therapies (XDR TB) are documented in over 50 countries, including the U.S., and we are seeing the emergence of strains that are fully resistant to treatment. And while the epidemic of TB is still primarily centered in the developing world, the reach of MDR extends to every continent, including both rich and poor countries. The global battle against TB, once thought won is today very real. The Institute of Medicine (IOM) Forum on Drug Discovery, Development, and Translation is conducting a series of workshops in the US and in high burden countries including South Africa, Russia, China, and India. The first workshop, held in November 2008, included experts from around the world, and was framed by a commissioned paper developed by Partners in Health that provided new data on the nature and spread of MDR TB. In addition, in February 2009, the Forum held a public briefing on MDR TB for Congressional staff in Washington, DC. Details of both meetings, including the agendas and speaker presentations, are available on the Forum s website ( IOM is partnering with the Academy of Science of South Africa (ASSAf) to convene a two-day workshop on MDR TB. The workshop will bring together disease experts, community leaders, policymakers, and patient advocates to examine the state of MDR TB in the South Africa region, to learn from the experiences of the South African public health community in its fight against MDR TB, and to draw lessons regarding best practices and novel approaches that can be applied both within and beyond the region. Proceedings of the workshop will be published and disseminated globally. The South Africa meeting will focus on various aspects of MDR TB: 1. Epidemiology. The latest information on the spread of MDR/XDR TB in Africa and globally, including the nature of the co-infection with HIV, will be presented and discussed. 2. Diagnostics and Preventive Therapies. The challenges associated with rapid diagnosis of TB and resistance testing in resource-constrained environments will be explored, as well as opportunities for expansion of laboratory capacity and point of care diagnosis. 3. Treatment. The limitations of current treatment, including the capacity of current health systems to address the needs of TB patients, the limited numbers of patients receiving appropriate treatment, and challenges in treating migrant workers, will be examined. 4. Transmission and Infection Control. The meeting will explore our growing understanding of the modes of transmission of MDR TB, and the strategies needed to address them. 5. Pediatric TB. The devastating spread of MDR TB among children, and the unique challenges they pose for prevention and treatment will be explored. 6. Policy. The workshop will analyze the effects of MDRTB beyond patients in order to highlight areas for improved policy and next steps. 1

2 Registration The Emerging Threat of Multidrug-Resistant Tuberculosis: Day 1 March 3, 2010 Breakfast and coffee will be served at this time Welcome and Opening Remarks Roseanne Diab, ASSAf Lerole David Mametja, Ministry of Health Perceptions vs. Realities: Summary of 2008 MDRTB Workshop in Washington, DC Gail Cassell, Eli Lilly Session 1: A Realistic Assessment of the Spread of MDR/XDR Tuberculosis in Sub-Saharan Africa with an Emphasis upon South Africa Moderator: Gerald Friedland, Yale School of Medicine Capacity for Health Care Across Southern Africa and MDR/XDR TB Tomas Zimba, Laboratorio de Microbiologica at Hospital Central de Maputo, Mozambique MDR/XDR TB in Ethiopia: A case study (Note: via phone) Anne Goldfeld, Harvard University Evolution of XDRTB in KwaZulu-Natal Willem Sturm, University of KwaZulu-Natal Prevalence of Drug Resistance at the initiation of second line drugs and existence of totally drug resistant TB Martie van der Walt, Medical Research Council Putting Resistance in Perpespective: the Korean Experience and Polymorphisms Associated with Resistance and Cross Resistance Clifton Barry, National Institute of Health Discussion with audience Lunch 2

3 Key Note Address Moderator: Janet Tobias, Ikana Media Epidemiology and Management of MDR TB in Children Simon Schaaf, Stellenbosch University Discussion with Audience Session 2: Coinfection with HIV Aids: Clinical Outcomes and Consequences Moderator: Richard Chaisson, Johns Hopkins University Tugela Ferry Experience in a Community Hospital Neel Gandhi, Einstein College of Medicine Outcomes from TB Referral Hospitals KZN Nesri Padayatchi, Univeristy of KwaZulu-Natal Outcomes from the Eastern Cape Charlotte Kvasnosky, Medical Research Council Mortality and Causes of Death in South Africa Maletela Tuoane-Nkhasi, Statistics South Africa Discussion with Audience BREAK Session 3: Alternative Strategies Moderator: Robin Wood, University of Cape Town Community Based Care Kristina Wallengren, Medical Research Council ART for the Prevention and Treatment of MDR TB Stephen Lawn, University of Cape Town Intensified TB case finding among HIV-infected patients Sabine Verkuijl, International Center for AIDS Care and Treatment Programs (ICAP-SA) Discussion with Audience 17:00 ADJOURN 1800 Group Dinner for Speakers 3

4 The Emerging Threat of Multidrug-Resistant Tuberculosis: Day 2 March 4, Session 4: Transmission and Strategies for Infection Control Moderator: Neel Gandhi, Einstein College of Medicine Proof of Priniciple: Transmistion of MDR TB in the AIR Facilities Matsie Mphahlele, Medical Research Council Epidemic in Tugela Ferry: Transmission and Impact of Infection Control Anthony Moll, Church of Scotland Hospital Household Contacts Caludio Marra, Church of Scotland Hospital Careworkers Karen Shean, University of Cape Town Migrant Workers in Lesotho Maketekete Thotolo, Adventist Development and Relief Agency An Evaluation of Infection Control Infrastructure and Health Worker KAP MDR/XDR TB Care Settings Jason E. Farley, Johns Hopkins University Discussion with Audience BREAK Session 5: Application of Molecular Biology to Shape Policy Moderator: Elaine Gallin, Doris Duke Charitable Foundation Drug Resistant Genotypes: implication for point of care detection of resistance in different geographies Paul van Helden, Stellenbosch University Genetic Analyis of Drug resistant strains in South Africa Robin Warren, Stellenbosch University Bench to Bush in biomarker Studies in Africa: Implications for MDR TB Treatment and Drug Development Shreemanta Parida, Max Planck Institute for Infection Biology, Berlin, Germany 4

5 Discussion with Audience LUNCH Session 6: How Close Are We? Moderator: Martie van der Walt, Medical Research Council Current Status of Diagnostics Globally for the Detection of Drug Resistance with Emphasis on Point of Care William Jacobs, Einstein School of Medicine Challenges in Laboratory Capacity in South Africa for Diagnosing drug resistance TB Gerrit Coetzee, Medical Research Council Information Solutions to Enhance Laboratory Capacity in evaluation of New diagnostics and therapies Dale Nordenberg, Novasano Health and Science Discussion with Audience Session 7: Research Gaps, Priorities and Opportunities Report from NIH Workshop Valerie Mizrahi, National Health Laboratory Service Barbara Laughon, National Institutes of Health Judith Hedje, National Institutes of Health Discussion with Audience BREAK Session 8: Convergence of Science and Policy to Create a Blueprint for Action Moderator: Queta Bond, Burroughs-Wellcome Fund (Retired) Where are we and where do we go from here? Salim Karim, University of KwaZulu-Natal Panelist Response: Gail Cassell, Eli Lilly Norbert Ndjeka, Department of Health Sidney Parsons, Council for Scientific and Industrial Research Discussion with Audience 1700 ADJOURN 5